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Objective: To describe hospital admissions of adolescents living in Sergipe, Northeast Brazil, from 2002 to 2012., Methods: Descriptive study, based on data collected from the Hospital Information System of the Unified Health System. Hospital admissions were divided into four groups of causes: by pregnancy, childbirth and puerperium; by external causes; by primary care conditions; and other causes. Numbers, percentages and coefficients were used in the analysis and compared by year, sex, age (from 10 to 14 and from 15 to 19 years), and the average annual cost of hospitalizations for each group of causes., Results: In the period studied, there were 149,850 hospital admissions of adolescents, 58.4% for pregnancy, childbirth and puerperium, 9.3% for primary care conditions, 8.3% for external causes and 24.0% for other causes. All coefficients decreased from 2002 to 2012 by 39.7%. Primary care conditions had the most significant reduction (143.1%), followed by external causes (60.1%). As for age groups, the coefficients for external causes in the age group of 15 to -19 years, and for pregnancy, childbirth and puerperium, in the age range of 10 to 14 years, are noteworthy because they remained stable in the period. There was an increase in the average cost of all admissions (234.7%), especially for external causes., Conclusions: Health actions to reduce hospital admission due to conditions sensitive to primary care should be given more attention, as well as those related to external causes and pregnancy, among adolescents living in Sergipe, Northeastern Brazil.

Background: Cause of death statistics are an important tool for quality control of the health care system. Their reliability, however, is controversial. Comparing death certificates with their corresponding medical records is implemented only occasionally but may point to quality problems. We aimed at exploring the agreement between information in the cause of death statistics and hospital discharge diagnoses at death., Methods: Selection of disease categories was based on ICD-10 Tabulation List for Morbidity and ICD-10 Mortality Tabulation List 2. Index cases were defined as deaths having occurred among Swiss residents 2010-2012 in a hospital and successfully linked to the Swiss National Cohort. Rare, external and ill-defined causes were excluded from comparison, leaving 53,605 deaths from vital statistics and 47,311 deaths from hospital discharge statistics. For 95% of individuals, respective information from the 2000 census could be retrieved and used for multiple logistic regression., Results: For 83% of individuals the underlying cause of death could be traced among hospital diagnoses and for 77% the principal hospital diagnosis among the cause of death information. Mirroring different evaluation of complex situations by individual physicians, rates of agreement varied widely depending on disease/cause of death, but were generally in line with similar studies. Multiple logistic regression revealed however significant variation in reporting that could not entirely be explained by age or cause of death of the deceased suggesting differential exploitation of available diagnosis information., Conclusion: Substantial regional variation and lower agreement rates among socially disadvantaged groups like single, less educated, or culturally less integrated persons suggest potential for improving reporting of diagnoses and causes of death by physicians in Switzerland. Studies of this kind should be regularly conducted as a quality monitoring.

Background: Medical certificates of cause of death (MCCOD) issued by hospital physicians are a key input to vital registration systems. Deaths certified by hospital physicians have been implicitly considered to be of high quality, but recent evidence suggests otherwise. We conducted a medical record review (MRR) of hospital MCCOD in the Philippines and compared the cause of death concordance with certificates coded by the Philippines Statistics Authority (PSA)., Methods: MCCOD for adult deaths in Bohol Regional Hospital (BRH) in 2007-2008 and 2011 were collected and reviewed by a team of study physicians. Corresponding MCCOD coded by the PSA were linked by a hospital identifier. The study physicians wrote a new MCCOD using the patient medical record, noted the quality of the medical record to produce a cause of death, and indicated whether it was necessary to change the underlying cause of death (UCOD). Chance-corrected concordance, cause-specific mortality fraction (CSMF) accuracy, and chance-corrected CSMF were used to examine the concordance between the MRR and PSA., Results: A total of 1052 adult deaths were linked between the MRR and PSA. Median chance-corrected concordance was 0.73, CSMF accuracy was 0.85, and chance-corrected CSMF accuracy was 0.58. 74.8% of medical records were deemed to be of high enough quality to assign a cause of death, yet study physicians indicated that it was necessary to change the UCOD in 41% of deaths, 82% of which required addition of a new UCOD., Conclusions: Medical records were generally of sufficient quality to assign a cause of death and concordance between the PSA and MRR was reasonably high, suggesting that routine mortality statistics data are reasonably accurate for describing population level causes of death in Bohol. While overall agreement between the PSA and MRR in major cause groups was sufficient for public health purposes, improvements in death certification practices are recommended to help physicians differentiate between treatable (immediate) COD and COD that are important for public health surveillance.

Background: Accurate and reliable hospital information on the pattern and causes of death is important to monitor and evaluate the effectiveness of health policies and programs. The objective of this study was to assess the availability, accessibility, and quality of hospital mortality data in Tanzania., Methods: This cross-sectional study involved selected hospitals of Tanzania and was carried out from July to October 2016. Review of hospital death registers and forms was carried out to cover a period of 10 years (2006-2015). Interviews with hospital staff were conducted to seek information as regards to tools used to record mortality data, staff involved in recording and availability of data storage and archiving facilities., Results: A total of 247,976 death records were reviewed. The death register was the most (92.3%) common source of mortality data. Other sources included the International Classification of Diseases (ICD) report forms, Inpatient registers, and hospital administrative reports. Death registers were available throughout the 10-year period while ICD-10 forms were available for the period of 2013-2015. In the years between 2006 and 2010 and 2011-2015, the use of death register increased from 82 to 94.9%. Three years after the introduction of ICD-10 procedure, the forms were available and used in 28% (11/39) hospitals. The level of acceptable data increased from 69% in 2006 to 97% in 2015. Inconsistency in the language used, use of non-standard nomenclature for causes of death, use of abbreviations, poorly and unreadable handwriting, and missing variables were common data quality challenges. About 6.3% (n = 15,719) of the records had no patient age, 3.5% (n = 8790) had no cause of death and ~ 1% had no sex indicated. The frequency of missing sex variable was most common among under-5 children. Data storage and archiving in most hospitals was generally poor. Registers and forms were stored in several different locations, making accessibility difficult., Conclusion: Overall, this study demonstrates gaps in hospital mortality data availability, accessibility, and quality, and highlights the need for capacity strengthening in data management and periodic record reviews. Policy guidelines on the data management including archiving are necessary to improve data.

Administrative data are often used as a proxy for medication-administration record (MAR) data. Multicenter MAR data were compared retrospectively with administrative data from January 2010 through June 2013 from the Pediatric Health Information Systems database. We found that administrative data were more concordant with bill-upon-administration than bill-upon-dispense data.

Aim: Sustained health inequities are experienced by indigenous and minority populations. Accurate ethnicity data are fundamental to healthcare planning and provision and monitoring of health outcomes to address such inequities. This study investigated the accuracy of ethnicity data in a large clinical registry of end-stage kidney disease patients (the Australia and New Zealand Dialysis and Transplant Registry; ANZDATA) and hospital-based patient clinical records compared with self-reported ethnicity data collected in the 'Dialysis Outcomes in those aged ≥65 years' (DOS65+) study., Methods: Self-reported ethnicity data were collected, as per national guidelines, from DOS65+ participants and compared with ethnicity data recorded for these participants in ANZDATA and hospital-based patient clinical records. Ethnicities were first prioritised and then grouped into one of the following: European, Māori, Pacific, Asian and Other. Cohen's Kappa statistics were calculated to determine overall non-random agreement. Concordances for ethnic group categories were calculated., Results: There was high concordance between self-reported ethnicity and ethnicity recorded in both the ANZDATA (κ=0.95) and hospital-based patient clinical records (κ=0.93). Concordances for ethnic group categories between datasets ranged from 86% to 100%., Conclusion: Our findings show a high level of agreement for ethnicity recorded for end-stage kidney disease patients between the three datasets, suggesting robust data to support health planning and research. Despite this, alignment of ethnicity data collection methods, as per national guidelines, should occur for all databases used for research and clinical practice in New Zealand., Competing Interests: Dr Derrett reports grants, personal fees and non-financial support from EuroQol Group outside the submitted work. Mr Page reports affiliation with Otago Medical Research Foundation—Lions Club of Dunedin South Summer Scholarship during the conduct of the study. Ms Walker reports grants from NZ Lotteries Health Research, grants from Baxter Health Care Research Programme, grants from University of Sydney APA Scholarship outside the submitted work. Mark Marshall is a full employee of Baxter Healthcare (Asia) Pte Ltd, Singapore.

Background: Digitized (scanned) medical records have been seen as a means for hospitals to reduce costs and improve access to records. However, clinical usability of digitized records can potentially have negative effects on productivity., Methods: Data were collected during follow-up outpatient consultations in two NHS hospitals by non-clinical observers using a work sampling approach in which pre-defined categories of clinician time usage were specified. Quantitative data was analysed using two-way ANOVA models and the Mann-Whitney U test. A focus group was held with clinicians to qualitatively explore their experiences using digitized medical records. The quantitative and qualitative results were synthesized., Results: Four hundred six consultations were observed. Using paper records, there was a significant difference in consultation times between hospitals (p = 0.016) and a significant difference in consultation times between specialties within hospitals (p = 0.003). Using digitized records there was a significant difference in consultation times between specialties within a hospital (p = 0.001). Excluding outliers, there was no significant difference between consultation times using digitized records compared with consultations using paper records in the same hospital, either at site (p > =0.285) or specialty level (p > =0.122). With digitized records at site A, two out of three specialties showed a significant increase in time spent searching computer records (p < =0.010, Δ = 01:50-07:10) and one specialty had a corresponding reduction in time spent searching paper records (p = 0.015, Δ = -00:28). Site B showed a notable increase in direct patient care (p < 0.001, Δ = 04:20-06:00) and time spent searching computer records (p < =0.043, Δ = 00:10-01:40) and reductions in the other time categories. The focus group confirmed that the most recent clinical letter was a vital document in the patient record, often containing most of the required information. Concerns were expressed about consistency of scanning practice, causing uncertainty about what could be relied upon to exist in the digitized record. Benefits of digitized records included: access from multiple locations, better prepared ward rounds, improved inpatient handovers and an improved timeline of patient events. Limitations of digitized records included: increased complexity of creating a patient summary, display of specialised content such as hand-drawn diagrams, inability to quickly flick through the pages to find relevant content., Conclusions: Digitized medical records can be implemented without detrimental operational impact. Inherent differences between specialties can outweigh the differences between paper and digitized records. Clear and consistent operational processes are vital for the reliability and usability of digitized medical records. Divergent views about usability (such as whether patient summary information is better or worse) may reflect familiarity with features of the digitized record.

Background: Hospital discharge records (HDRs) are routinely used to assess outcomes of care and to compare hospital performance for heart failure. The advantages of using clinical data from medical charts to improve risk-adjustment models remain controversial. The aim of the present study was to evaluate the additional contribution of clinical variables to HDR-based 30-day mortality and readmission models in patients with heart failure., Methods: This retrospective observational study included all patients residing in the Local Healthcare Authority of Bologna (about 1 million inhabitants) who were discharged in 2012 from one of three hospitals in the area with a diagnosis of heart failure. For each study outcome, we compared the discrimination of the two risk-adjustment models (i.e., HDR-only model and HDR-clinical model) through the area under the ROC curve (AUC)., Results: A total of 1145 and 1025 patients were included in the mortality and readmission analyses, respectively. Adding clinical data significantly improved the discrimination of the mortality model (AUC = 0.84 vs. 0.73, p < 0.001), but not the discrimination of the readmission model (AUC = 0.65 vs. 0.63, p = 0.08)., Conclusions: We identified clinical variables that significantly improved the discrimination of the HDR-only model for 30-day mortality following heart failure. By contrast, clinical variables made little contribution to the discrimination of the HDR-only model for 30-day readmission.

Background: Clinical data gathered for administrative purposes often lack sufficient information to separate the records of radiotherapy given for palliation from those given for cure. An absence, incompleteness, or inaccuracy of such information could hinder or bias the study of the utilization and outcome of radiotherapy. This study has three specific purposes: 1) develop a method to determine the therapeutic role of radiotherapy (TRR); 2) assess the accuracy of the method; 3) report the quality of the information on treatment "intent" recorded in the clinical data in Ontario, Canada. A general purpose is to use this study as a prototype to demonstrate and test a method to assess the quality of administrative data., Methods: This is a population based retrospective study. A random sample was drawn from the treatment records with "intent" assigned in treating hospitals. A decision tree is grown using treatment parameters as predictors and "intent" as outcome variable to classify the treatments into curative or palliative. The tree classifier was applied to the entire dataset, and the classification results were compared with those identified by "intent". A manual audit was conducted to assess the accuracy of the classification., Results: The following parameters predicted the TRR, from the strongest to the weakest: radiation dose per fraction, treated body-region, disease site, and time of treatment. When applied to the records of treatments given between 1990 and 2008 in Ontario, Canada, the classification rules correctly classified 96.1% of the records. The quality of the "intent" variable was as follows: 77.5% correctly classified, 3.7% misclassified, and 18.8% did not have an "intent" assigned., Conclusions: The classification rules derived in this study can be used to determine the TRR when such information is unavailable, incomplete, or inaccurate in administrative data. The study demonstrates that data mining approach can be used to effectively assess and improve the quality of large administrative datasets.

Introduction: Patients undergoing elective surgery, require a comprehensive clinical treatment that tends to maintain or prevent deterioration of nutritional status and promote clinical outcomes, and in turn improve the safety of parenteral nutrition therapy through optimization of technology, as a option aimed at minimizing risk and lower operating costs in institutions providing health services., Aim: To review the literature in order to study the requirements and recommendations of peripheral parenteral nutritional support and / or complementary ready to use in people undergoing surgery., Methods: Data synthesis after reviewing the relevant literature, to allow the protocol design. The search was conducted in the following databases: PubMed, Medline, Embase and ScienceDirect., Conclusions: Peripheral parenteral nutrition is a ready to use alternative nutritional support that improves the contribution Protein-Energy and demonstrate improvements in patient safety, decrease costs and increase patient satisfaction., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Background: Reliable, timely information is the foundation of decision making for functioning health systems; the quality of decision making rests on quality data. Routine monitoring, reporting, and review of cesarean section (CS) indications, decision-to-delivery intervals, and partograph use are important elements of quality improvement for maternity services., Methods: In 2009 and 2010, a sample of CS records from calendar year 2008 was reviewed at nine facilities in Bangladesh, Guinea, Mali, Niger, and Uganda. Data from patient records and hospital registers were collected on key aspects of care such as timing of key events, indications, partograph use, maternal and fetal outcomes. Qualitative interviews were conducted with key informants at all study sites to provide contextual background about CS services and record keeping practices., Results: A total of 2,941 records were reviewed and 57 key informant interviews were conducted. Patient record-keeping systems were of varying quality across study sites: at five sites, more than 20% of records could not be located. Across all sites, patient files were missing key aspects of CS care: timing of key events (e.g., examination, decision to perform CS), administration of prophylactic antibiotics, maternal complications, and maternal and fetal outcomes. Rates of partograph use were low at six sites: 0 to 23.9% of patient files at these sites had a completed partograph on file, and among those found, 2.1% to 65.1% were completed correctly. Information on fetal outcomes was missing in up to 40% of patient files., Conclusions: Deficits in the quality of CS patient records across a broad range of health facilities in low-resource settings in four sub-Saharan Africa countries and Bangladesh indicate an urgent need to improve record keeping.

Background: Administrative databases have become an important tool to monitor diseases. Patients with epilepsy could be traced using disease-specific codes and prescriptions, but formal validation is required to obtain an accurate case definition. The aim of the study was to correlate administrative data on epilepsy with an independent source of patients with epilepsy in a district of Lombardy, Northern Italy, from 2000 to 2008., Methods: Data of nearly 320 600 inhabitants in the district of Lecco collected from the Drug Administrative Database of the Lombardy Region were analysed. Among them were included patients who fulfilled the International Classification of Diseases 9 (ICD-9) codes and/or the disease-specific exemption code for epilepsy and those who had at least one EEG record and took antiepileptic drugs (AEDs) as monotherapy or in variable combinations. To ascertain epilepsy cases, 11 general practitioners (GPs) with 15 728 affiliates were contacted. Multiple versions of the diagnostic algorithm were developed using different logistic regression models and all combinations of the four independent variables., Results: Among the GP affiliates, 71 (4.5/1000) had a gold standard diagnosis of epilepsy. The best and most conservative algorithm included EEG and selected treatment schedules and identified 61/71 patients with epilepsy (sensitivity 85.9%, CI 76.0% to 92.2%) and 15 623/15 657 patients without epilepsy (specificity 99.8%,CI 99.7% to 99.8%). The positive and negative predictive values were 64.2% and 99.9%. Sensitivity (86.7%) and the positive predictive value (68.4%) increased only slightly when patients with single seizures were included., Conclusions: A diagnostic algorithm including EEG and selected treatment schedules is only moderately sensitive for the detection of epilepsy and seizures. These findings apply only to the Northern Italian scenario.

Background: Linkage between routinely collected hospital birth and other records offers the potential for epidemiological and public health research by developing population-level birth cohorts with cradle-to-grave follow-up. Data from births in English National Health Service hospitals are collected in the Hospital Episode Statistics (HES) database but are of uncertain quality., Methods: We examined the range and completeness of birth information recorded in HES and tested an approach for minimizing the effect of hospital-level variations by selecting hospitals with high completeness of recording (≥ 90%) for key fields. We discuss important methodological considerations when using routine healthcare data to develop a birth cohort., Results: The proportion of missing data in key birth record fields has been decreasing annually, such as gestational age and birth weight (from 46.2 and 43.9% in 2005/06 to 18.1 and 16.9% in 2009/10, respectively). We compared the important characteristics such as size and access to specialist neonatal care between 71 high-coding and 85 low-coding hospitals and found no significant differences, suggesting hospitals with high birth record completeness may be generalizable and representative of all hospitals., Conclusions: The completeness of recording of hospital birth information varies greatly between hospitals in England but is improving. It may be preferable and valid to construct cohorts from only hospitals with high completeness of recording.

Objective: To present the epidemiological profile of cancer patients belonging to a database of a Hospital Cancer Registry and to report on the importance of this database in managing healthcare services at an Oncology and Hematology Center., Methods: A retrospective survey conducted with 1617 records of patients diagnosed with cancer at the institution between 2004 and 2009. The types of cancer analyzed were of the colon and rectum, breast, prostate and lung. The variables used in the study were age, gender, stage of disease upon diagnosis and treatment. Researchers used an application called SisHCR for data collection, and Excel® for data analysis. To ensure data safety and reliability, passwords were required for accessing files, spreadsheets were backed up on a weekly basis, and patients' CPF numbers were used to avoid data duplication., Results: Of the 1617 records analyzed, 36.42% belonged to the topographic group of the breast, and approximately 40% of patients with colorectal cancer were 70 years of age or older. Stage II was prevalent, representing 44% of the sample, and the treatment most used was surgery (57% of cases)., Conclusion: The study suggested that the Hospital Cancer Registry database is an instrument capable of generating important information about cancer, and that through this information, epidemiological studies can be carried out and the processes of management and care can be improved.

We validated population-based hospital, emergency room, and physician claim databases for the detection of surgical site infections against the reference standard of clinical surveillance. Although these data sets are highly specific and could be used to define research cohorts, their low sensitivity and positive predictive value make them inadequate for use as quality indicators.

Record Keeping Standards is a development led by the Royal College of Physicians of London (RCP) Health Informatics Unit and funded by the National Health Service (NHS) Connecting for Health. A supplementary report produced by the RCP makes a number of recommendations based on a study held at an acute hospital trust. We audited the medical notes and coding to assess the accuracy, documentation by the junior doctors and also to correlate our findings with the RCP audit. Northern Lincolnshire & Goole Hospitals NHS Foundation Trust has 114,000 'finished consultant episodes' per year. A total of 100 consecutive medical (50) and rheumatology (50) discharges from Diana Princess of Wales Hospital from August-October 2009 were reviewed. The results showed an improvement in coding accuracy (10% errors), comparable to the RCP audit but with 5% documentation errors. Physician involvement needs enhancing to improve the effectiveness and to ensure clinical safety.

Background: Diagnosis information from existing data sources is used commonly for epidemiologic, administrative, and research purposes. The quality of such data for emergency department (ED) visits is unknown., Objectives: To determine the agreement on final diagnoses between two sources, electronic administrative sources and manually abstracted medical records, for pediatric ED visits, in a multicenter network., Methods: This was a cross sectional study at 19 EDs nationwide. The authors obtained data from two sources at each ED during a three-month period in 2003: administrative sources for all visits and abstracted records for randomly selected visits during ten days over the study period. Records were matched using unique identifiers and probabilistic linkage. The authors recorded up to three diagnoses from each abstracted medical record and up to ten for the administrative data source. Diagnoses were grouped into 104 groups using a modification of the Clinical Classification System., Results: A total of 8,860 abstracted records had at least one valid diagnosis code (with a total of 12,895 diagnoses) and were successfully matched to records in the administrative source. Overall, 67% (95% confidence interval = 66% to 68%) of diagnoses from the administrative and abstracted sources were within the same diagnosis group. Agreement varied by site, ranging from 54% to 77%. Agreement varied substantially by diagnosis group; there was no difference by method of linkage. Clustering clinically similar diagnosis groups improved agreement between administrative and abstracted data sources., Conclusions: ED diagnoses retrieved from electronic administrative sources and manual chart review frequently disagree, even if similar diagnosis codes are grouped. Agreement varies by institution and by diagnosis. Further work is needed to improve the accuracy of diagnosis coding; development of a grouping system specific to pediatric emergency care may be beneficial.

Objective: To examine the use of unspecified codes for the circumstances of injury for New Zealand public hospital discharges at a district health board (DHB) level., Methods: Hospital injury discharges for the period 2000-3 were examined. The use of the International Classification of Diseases unspecified categories was examined for mechanism of injury, activity and place of occurrence., Results: For all DHBs, the combined age-adjusted and mechanism-adjusted usage of unspecified mechanism codes was 7% and ranged from 3% to 11%. Most (57%) of these cases were unspecified falls. The comparable usage for activity was 39% and ranged from 17% to 52%, and for place of occurrence the respective figures were 23% and 7-36%. Only 50% of hospital discharges were completely specified in terms of mechanism of injury, activity and place of occurrence; this varied from 36% to 74% between DHBs. For several DHBs a significant degree of inconsistency was found in performance across mechanism, activity and place of occurrence coding., Conclusions: Those DHBs with a high proportion of cases coded as unspecified would serve the prevention efforts of their communities better by making efforts to determine the cause of this situation and implement measures to reduce the problem.

Objectives: This research identifies the level of specificity of cause-of-injury morbidity data in Australia. The research explores reasons for poor-quality data across different causes-of-injury areas, including a lack of clinical documentation and insufficient detail in the classification system., Methods: The 2002/03 hospital morbidity dataset of 593,079 injury-related hospital admissions was analysed to examine the specificity of coded external cause-of-injury data., Results: While overall specificity appeared high, the cause of 47,660 injuries was not specifically defined according to the code assigned. Only 56% of cases for whom injury was the result of an accidental fall were assigned a specific code to identify the causal detail; 19% were assigned an 'Other Specified' fall code, suggesting a lack of specific code availability; and 25% were assigned an 'Unspecified Fall' code, suggesting a lack of clinical documentation to facilitate code selection., Conclusions: To improve the quality of injury-related hospital morbidity data, two main areas to focus resources are: 1) the development of more specific cause-of-injury codes; and 2) the provision of more detailed documentation from clinicians., Implications: Clinicians and clinical coders need to work together to improve the quality of injury-related coded data through the provision of specific codes and improved clinical documentation. Accurate and comprehensive data pertaining to the circumstances surrounding hospitalised injury events will benefit injury prevention and surveillance initiatives, provide justification for resources related to injury hospitalisation, and assist in external cause research in Australia.

We have recently demonstrated that the distribution of total time spent by patients in emergency departments (EDs) in England shows a peak immediately prior to the current Department of Health target of 4 hours. We aimed to investigate whether this suggested that performance data were being manipulated. We collected data from 117 EDs, and 616,067 patient episodes were included in the analysis. Evidence of manipulation of performance data appears to be present in a small proportion of episodes, but because of the numbers involved, it could equate to over 50,000 episodes per year in EDs in England.

Objectives: To identify and describe work related serious injuries among sawmill workers in British Columbia, Canada using hospital discharge records, and compare the agreement and capturing patterns of the work related indicators available in the hospital discharge records., Methods: Hospital discharge records were extracted from 1989 to 1998 for a cohort of sawmill workers. Work related injuries were identified from these records using International Classification of Disease (ICD-9) external cause of injury codes, which have a fifth digit, and sometimes a fourth digit, indicating place of occurrence, and the responsibility of payment schedule, which identifies workers' compensation as being responsible for payment., Results: The most frequent causes of work related hospitalisations were falls, machinery related, overexertion, struck against, cutting or piercing, and struck by falling objects. Almost all cases of machinery related, struck by falling object, and caught in or between injuries were found to be work related. Overall, there was good agreement between the two indicators (ICD-9 code and payment schedule) for identifying work relatedness of injury hospitalisations (kappa = 0.75, p < 0.01). There was better concordance between them for injuries, such as struck against, drowning/suffocation/foreign body, fire/flame/natural/environmental, and explosions/firearms/hot substance/electric current/radiation, and poor concordance for injuries, such as machinery related, struck by falling object, overexertion, cutting or piercing, and caught in or between., Conclusions: Hospital discharge records are collected for administrative reasons, and thus are readily available. Depending on the coding reliability and validity, hospital discharge records represent an alternative and independent source of information for serious work related injuries. The study findings support the use of hospital discharge records as a potential surveillance system for such injuries.

Objectives: To assess level of fulfillment and utility of the hospital discharge register (HDR) as a complementary source of information for estimating the number of deaths at 30 days due to motor vehicle crashes in Spain., Methods: It is a cross-sectional study were we compared the number of people injured due to motor vehicle crashes hospitalised in a public hospital (HDR), in Spain during 2001, with the number of people severely injured or killed due to motor vehicle crashes reported by the police database (Dirección General de Tráfico, DGT) for the same year. A descriptive analysis was carried out by age, sex and region (Autonomous Community), as well as an estimation of the percentage of under-reporting of deaths by the DGT based on two assumptions., Results: Police reported 27,272 severe injuries and 4,811 deaths during first 24 hours after the crash and after applying a fatality adjustment factor estimated 706 more deaths up to 30 days after the crash. The HDR reported 40,174 urgent hospitalisations. Of these, 1,099 died during the day of hospitalisation or within the following 30 days. The police only notified 68% of all cases that required hospitalisation. According to the number of deaths reported by police and contrasted with hospital register, estimations of the number of deaths at 30 days made by police could represent a level of under-reporting of between 3% and 6.6%, depending on the assumption considered., Conclusions: This study showed that the HDR is an information source that complements police statistics and is useful to estimate the number of deaths and non-fatal injuries due to motor vehicle crashes in Spain.

Background: Federal regulation requires hospitals to present patients with a Notice of Privacy Practices (NPP) that contains all stipulated content items, is readable by patients, and posted on institutional web sites., Objective: The objective of this study was to determine whether the NPP texts contain the required content, if readability is influenced by local literacy rates, and if readability or the presentation of NPP texts in other languages is influenced by local rates of English proficiency., Research Design: The authors conducted a cross-sectional study of the web sites of 115 hospitals selected from the US News and World Report list: Best Hospitals in America., Measures: English NPP texts were evaluated for 18 content items and readability using the Flesch-Kincaid scale, which assigns the minimal grade level required to read a text (range, 0-16)., Results: NPP texts were available for all hospitals (115 of 115). A Spanish-language NPP was available for 25% (29 of 115). All content items were evident in 76% (87 of 115) of hospitals' NPP texts. The average grade-level readability of NPP text was 12.3 (95% confidence interval, 12.0-12.7). Readability was not associated with the rate of local literacy (P = 0.07). Hospitals with a lower local rate of English proficiency had NPP texts that were more difficult to read (P = 0.03) and did not present NPP texts in other languages more frequently (P = 0.15)., Conclusions: Although NPP texts typically cover the stipulated content, they are written beyond the reading capacity of the majority of American adults. Explicit federal guidance is needed to help privacy lawyers draft NPP texts that are both comprehensive and comprehensible. The goals of the Health Insurance Portability and Accountability Act of 1996 Privacy Rule cannot be met with NPP texts patients cannot decipher.

Background: Ambulatory care-sensitive hospitalization rates derived from hospital discharge data have been used to compare ambulatory care across insurance and delivery system groups., Objective: We sought to quantify the impact of coding inaccuracies in hospital discharge data on counts of hospitalizations for ambulatory care-sensitive conditions among Medicaid beneficiaries., Methods: This was a cross-sectional comparison of administrative databases of all California Medicaid beneficiaries younger than 65 years of age. We compared the number of hospitalizations that were attributed to Medicaid beneficiaries in California's hospital discharge data for 1994 to 1999 with the number derived from a file that linked hospital discharge data with the Medicaid eligibility file., Results: Hospital discharge data undercounted 28.2% of hospitalizations for ambulatory care-sensitive conditions among Medicaid beneficiaries and overcounted 13.4% of such admissions among non-Medicaid beneficiaries. Approximately 5% of hospitalizations for ambulatory care-sensitive conditions captured as Medicaid admissions in routine hospital discharge data were among patients who gained Medicaid coverage as a result of the hospitalization. Patients who acquire Medicaid coverage as a result of a hospitalization are much more likely to be placed into Medicaid fee for service rather than Medicaid managed care which biases comparisons of these 2 delivery models., Conclusion: Caution should be used in the interpretation of Medicaid hospitalization rates as calculated from routine hospital discharge data. State agencies that provide hospital discharge data should consider the opportunity to improve the evaluation of Medicaid services by linking hospital discharge data with Medicaid enrollment files.

Use of the traditional mechanism for cancer surveillance, hospital-based registries, may limit ascertainment of incident cases. In this study, the authors evaluated the ability of a statewide hospital discharge file (HDF) to enhance central cancer registry reporting. Incident cancers from a Virginia cancer registry were linked with an HDF for 1995. Medical record abstractions for over 2,000 cancers verified HDF and registry data. There were 19,740 unique cases ascertained from the two combined data sources. The registry captured approximately 83% of cases, while the HDF captured 62%. Although the HDF missed a substantial number of registry cases, the HDF positive predictive value for identifying the correct cancer site was 94%. Logistic regression was used to identify significant characteristics of cases likely to be captured only by the HDF; these characteristics included hospital cancer program certification, the position of the cancer diagnosis on the claim, and cancer surgery. This study represents the evaluation of a novel approach to enhancing registry completeness and accuracy using statewide HDFs. The results strongly suggest that neither a central cancer registry nor an HDF is a sufficient source for complete capture of cases. Using HDFs to supplement a central cancer registry may be a valuable and efficient method for improving registry completeness of reporting.

We did a survey of postoperative wound infection rates in our department over a 10-year period. It was based on the results of forms completed by surgeons in the department after each operation and when an infection was diagnosed (primary registration). These forms were sent to the electronic data processing department for registration of data in a database. Every third month, detailed reports of the data were discussed with the surgeons. The quality of this routine survey was evaluated as follows: 1) Every year, the year's data in the surveys database were compared with those in the National Patient Register and, in case of discrepancies, the patient's records were checked and missing information about the operation and infections were recorded in the surveys database (secondary registration). 2) In case of a primary registered infection, the patient's record was carefully examined. Infections not fulfilling the criteria for an infection were called registration failures. The primary registration of operations reached an acceptable level (about 95%) after 5 years of the survey, but the recording of infections was unreliable throughout the study due to an unacceptably low registration rate (about 60%) and to a high rate of registration failures.

Background: The National Service Framework (NSF) for Coronary Heart Disease requires annual clinical audit of the care of patients with myocardial infarction, with little guidance on how to achieve these standards and monitor practice., Aim: To assess which method of identification of acute myocardial infarction (AMI) cases is most suitable for NSF audit, and to determine the effect of the definition of AMI on the assessment of quality of care., Design: Observational study., Methods: Over a 3-month period, 2153 consecutive patients from 20 hospitals across the Yorkshire region, with confirmed AMI, were identified from coronary care registers, biochemistry records and hospital coding systems. The sensitivity and positive predictive value of AMI patient identification using clinical coding, biochemistry and coronary care registers were compared to a 'gold standard' (the combination of all three methods)., Results: Of 3685 possible cases of AMI singled out by one or more methods, 2153 patients were identified as having a final diagnosis of AMI. Hospital coding revealed 1668 (77.5%) cases, with a demographic profile similar to that of the total cohort. Secondary preventative measures required for inclusion in NSF were also of broadly similar distribution. The sensitivities and positive predictive values for patient identification were substantially less in the cohorts identified through biochemistry and coronary care unit register. Patients fulfilling WHO criteria (n=1391) had a 30-day mortality of 15.9%, vs. 24.2% for the total cohort., Discussion: Hospital coding misses a substantial proportion (22.5%) of AMI cases, but without any apparent systematic bias, and thus provides a suitably representative and robust basis for NSF-related audit. Better still would be the routine use of multiple methods of case identification.

Background: This prospective and retrospective study carried out over a period of one month (50 patients) looked at the quality of hospital records of urethral catheterisation with reference to the hospital protocol. The patients were catheterised on general surgical wards as well as in theatre., Results: The quality of hospital records of this procedure was poor and a number of complications noted., Conclusions: Good documentation of urethral catheterisation would result in a better quality of audit and, therefore, identify potential ways of minimising complications. We recommend this by regular audit of hospital records, re-inforcement of protocols and informed consent of this procedure, with particular reference to theatre.

Background: When a patient is admitted to a hospital, the need for information about the medications prescribed is an important issue., Objectives: Our aim was to assess whether electronic communication between the GP and the pharmacist provides better information regarding current medication when a patient is admitted to the hospital than paper-based communication., Methods: A prospective study was carried out whereby on the day of admission and 10 days after discharge, three different data collectors independently asked the patient, the GP and the pharmacist details of the patient's current medication. Five GPs and a local pharmacy relying on electronic communication, and five GPs and a local pharmacy relying on paper-based communication were studied., Results: A total of 139 patients were included on the first day of their admission, and 116 on the tenth day after discharge. Of the 275 drugs that the patient, the GP and/or the pharmacist reported on admission in the electronic group, 134 (49%) were reported by the patient, the GP and the pharmacist, and 79 (29%) were not reported by the patient. For the paper group, these figures were 340 drugs on admission, of which 107 (31%) were reported by the patient, the GP and the pharmacist, while 130 (38%) were not reported by the patient., Conclusions: We conclude that electronic communication between the GP and the community pharmacist results in a better agreement between them with respect to the current medication of the patient than paper-based communication. However, electronic communication does not suffice as a solution to obtain reliable information.

The SAEM EC Categorization Task Force was developed in response to the 1994 Macy Foundation's recommendation that emergency medicine (EM) organizations "should revise the classification of emergency departments ... to reflect the level of care available in emergency departments, and indicate whether or not facilities are adequate and whether appropriately qualified and credentialed emergency physicians are available 24 hours a day." By holding Level 1 emergency centers (ECs) to objective standards based on the quality of care delivered as well as administrative, research, and educational efforts, SAEM hopes to improve patient care. The SAEM EC Categorization Task Force is now beginning the process of reviewing ECs that provide comprehensive emergency care and serve as regional resources for education, research, and administration in EM. This standards document describes relative and critical criteria to be met in order to receive designation as a Level 1 emergency center. Such centers must meet all critical criteria, and be in sufficient compliance with most or all relative criteria, in order to achieve this designation. This process is entirely voluntary. Any EC is eligible for review. Any institution can initiate the review process by applying. Application materials and further information, including the policies and procedures of the SAEM EC Categorization Task Force, are available from SAEM.

This study examined the reliability of hand written and computerised records of birth data collected during the Birth to Ten study at Baragwanath Hospital in Soweto. The reliability of record-keeping in hand-written obstetric and neonatal files was assessed by comparing duplicate records of six different variables abstracted from six different sections in these files. The reliability of computerised record keeping was assessed by comparing the original hand-written record of each variable with records contained in the hospital's computerised database. These data sets displayed similar levels of reliability which suggests that similar errors occurred when data were transcribed from one section of the files to the next, and from these files to the computerised database. In both sets of records reliability was highest for the categorical variable infant sex, and for those continuous variables (such as maternal age and gravidity) recorded with unambiguous units. Reliability was lower for continuous variables that could be recorded with different levels of precision (such as birth weight), those that were occasionally measured more than once, and those that could be measured using more than one measurement technique (such as gestational age). Reducing the number of times records are transcribed, categorising continuous variables, and standardising the techniques used for measuring and recording variables would improve the reliability of both hand-written and computerised data sets.

Objective: To analize the number, characteristics and content of the articles on quality evaluation of health records and information systems published by Spanish authors in biomedical journals (1983-1992)., Material and Methods: Sources were IME and MEDLINE databases, journal summaries and bibliographies from the retrieved items. Originals or review articles and communications were included. Variables analyzed were: publication date; kind of document; coauthorship number; authors/items ratio; institutions where the authors work; journal of publication. The content analysis included the main aspects studied and the kind of document or system investigated., Results: 87 documents were retrieved, 74 being original papers and 13 communications. Along the period a gradual growth was observed and a maximum was reached in 1991 with 18 items. The total number of authors was 370, 5 authors with three or more items. The maximum number of items per author was 6. The ratio authors/items was 4.1. The most productive institutions were hospitals and governmental centers. Twenty four different journals were identified, 5 publishing the 74.4% of papers. 61 (82.4%) of the 74 articles correspond to evaluative research and 13 (17.6%) dealt with questions related with quality but were not evaluative researches. The questions more frequently evaluated in the 61 articles were the completeness of data in clinical records (22 articles); the accuracy of data recorded in the documents used for death certification (7 articles) and the accuracy of data recorded in the Hospital Patient's Logbook (5 articles)., Discussion: An increase of scientific production in this field and its concentration in a reduced number of magazines has taken place in Spain in the past few years of study. The content in most of the articles is about formal aspects of clinic and sanitary information.

Aims: To assess the availability and completeness of existing hospital records, required for a proposed case-control study of vitamin K administration to neonates and childhood cancer., Methods: We surveyed 44 hospitals, to see whether they had kept records for children born during 1962-87. Additionally, we sought the neonatal records of 44 Dunedin-born people who would be in the proposed study if it went ahead. We abstracted details of vitamin K administration from the records found., Results: There were 36 responses to our survey (82%). For two-thirds of the hospitals, neonatal records were not available for all of the period 1962-87. The commonest reason for unavailability of records was that they had been destroyed. Neonatal records could be found for 34 (77%) of those born in Dunedin. Although 30 records indicated that vitamin K had been given, only 17 gave the route of administration., Conclusions: Our proposed study is not feasible because of the poor availability of records and the lack of details recorded. We support the introduction of regulations requiring hospitals to retain health information for a specified time, and we argue that the minimum period for hospitals should be longer than has been proposed.

Demand for quality of care data has led to publication of adjusted mortality rates of hospitals and physicians. Yet the accuracy of databases used for this purpose is questionable, raising the possibility that consumer-oriented profiles of providers could be misleading. A stratified random sample of discharge abstract records of Medicare-aged patients hospitalized in California were audited by the state's health data agency. The results of the audit were analyzed to determine the effect that coding errors have on expected death rates assigned to hospitals as risk-adjustment measures in the annual Medicare hospital mortality report. Discharge abstracts of Medicare-aged patients contained many errors among coded risk factors used to calculate expected death rates. Comorbidities and transfers from nursing homes were seriously underreported and 'urgency of admission' was often miscoded. Hospitals differed with respect to error rates (P < .0001); these varying levels of miscoding caused measurement errors that ranged in size from 0.2 to 2.2 expected 30-day deaths per 100 admissions (10th vs. 90th percentile). Detailed knowledge of the limitations of claims data can help analysts minimize the impact of coding error. Beyond this, quality control of data used for outcomes research needs strengthening.

A programme of repeated personal reminders substantially reduced the delay in producing final histological reports for necropsy cases. The proportion delayed for over four weeks was reduced from 69.7% to 46.7%, and the proportion delayed for over 10 weeks was reduced from 38.6% to 11.7%. This improvement may contribute to halting and reversing the now established trend in the decline of necropsy rates.

In this article the organization and accuracy of the population registry and administrative data base in Manitoba, Canada are discussed. The overall data management strategy and a framework for analyzing the accuracy of such data are presented. The generally high quality of the Manitoba registry file (necessary to track individuals over time) and the hospital claims is supported by comparisons with other data sources. Hospital claims' main quality problems concern the reliability of certain secondary diagnoses and the level of aggregation necessary for reasonable agreement with other data collection methods (such as chart reviews). Finally, some of the research possibilities associated with population registries and administrative data are outlined.

Study Objective: The aim was to assess the extent to which routinely collected data on poisoning in adolescents reflected deliberate self poisoning and, in doing, so to assess the accuracy of the diagnostic information on poisoning in the routine hospital abstracts which form the joint data base of Hospital Activity Analysis and the Oxford Record Linkage Study (ORLS)., Design: A comparison was made (a) of all eligible ORLS records during the study period with an independent source of records; and (b) of a random sample of records from an independent source with ORLS., Setting: Records of patients admitted to the John Radcliffe Hospital in Oxford were used., Subjects: These were (a) patients aged 10-20 years between 1980 and 1985 with a diagnosis of poisoning by drugs and medicaments in ORLS; (b) a random sample of 500 patients selected from the self harm monitoring files at the hospital (12 patients were not eligible for inclusion in ORLS and were therefore excluded from the rest of the study)., Measurements and Main Results: The recorded diagnosis was compared on the records selected from the two files. Of the 1123 events of poisoning identified in ORLS, 1081 (96.3%) were correctly coded as poisoning and 1065 (95%) of these were deliberate self poisoning. Of the 488 cases from the monitoring files, 467 (95.7%) of all cases had a correct diagnosis of injury or poisoning on the ORLS file. Of the 453 poisoning cases 436 (96.2%) were correctly recorded in ORLS., Conclusions: Deliberate self poisoning in adolescents can be identified through routinely collected hospital statistics. A very high percentage of the diagnostic information on poisoning in ORLS files is correctly recorded.

The purpose of this notice is to announce the 1984 Revision of the Uniform Hospital Discharge Data Set (UHDDS) which has been approved by the Secretary for use within the Department of Health and Human Services (DHHS). The purposes of the 1984 revision are to update and improve the original version of the UHDDS which was promulgated by the Secretary in 1974 as a minimum, common core of data for use in programs of the Department which require data on individual hospital discharges on a continuing basis. Revisions to definitions and categories have been developed to update certain items and to improve their accuracy.

Data based on medical records of discharged hospital patients are widely used. However, recent studies of the reliability of discharge data have found error rates which appear to be high, in view of the important data uses. In this paper, the procedures reportedly followed to control the quality of discharge data by private abstracting services, the national Hospital Discharge Survey and the Medicare system are described. Some weaknesses of the quality controls of the existing systems are identified. Recommendations are made for reducing duplicate data collection efforts, and for studies of the relative effectiveness and costs of various quality control procedures.

Records of hospital inpatients were abstracted for 5,000 newly diagnosed cancer patients admitted in 1982-83 to 17 Comprehensive Cancer Centers and 17 Community Hospital Oncology Programs. Generally available data items (silent record rate less than 5 per cent for the typical institution) included: age, race, sex, dates of hospitalization, zip code of residence, pathological stage, dates of biopsy and surgery, numbers of nodes examined and positive, certain diagnostic procedures, and some radiotherapy descriptors. For other data items, there was enormous variability in completeness and high institution-to-institution variation. Record completeness did not differ consistently between comprehensive and community cancer centers. We conclude that the hospital patient record is useful for tracking the frequency of surgical and related events. However, studies of diagnostic and therapeutic procedures should not rely solely on the hospital medical record due to the high rates of silent records.

Hospitals are now being reimbursed by Diagnosis Related Group (DRG) for Medicare patients. The Johns Hopkins Hospital has worked successfully under this system for the past 5 years, with cost increases being maintained well below the national average. Allowable revenue varies considerably by diagnosis depending on such factors as secondary diagnoses, procedure, and patient age. Failure to document accurately may result in substantial loss of hospital income. More worrisome is the use of data by outside agencies to evaluate quality of care. Recent reports of mortality rates for surgery in Maryland hospitals and of permanent pacemaker use are illustrative. Conclusions were inaccurate because of inadequate documentation of diagnoses and procedures by physicians and inaccurate coding by quality assurance coordinators. Surgeons need to be aware that in the prospective payment era, accurate and complete documentation is essential and that their data are likely to be used for purposes other than monitoring fiscal performance.